Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor in the treatment of non–ST-segment elevation acute coronary syndromes

Schwenkglenks, Matthias; Brazier, John; Szucs, Thomas D.; Fox, Keith A.A.

doi:10.1016/j.jval.2010.10.025

Cited by 17 publications

(14 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Guidance documents issued by NICE and by the Scottish Medicines Consortium were informed by the analysis presented here and by an earlier version reflecting the Scottish setting 12 37. A previous cost-effectiveness analysis for UK patients with NSTE-ACS used the same analytical framework but favoured bivalirudin less strongly than the present analysis 13. This result is consistent given smaller clinical effect sizes and longer anticoagulant and GPI administration times.…”

Section: Discussionsupporting

confidence: 86%

“…The long-term life expectancy of STEMI patients, utility values (ie, quality of life weights) and unit costs were drawn from UK sources. A similar approach was previously used in a cost-effectiveness analysis of bivalirudin in the treatment of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) 13. Details on model assumptions and input parameters are provided below and in the online supplement.…”

Section: Methodsmentioning

confidence: 99%

“…The health economic model was implemented using a published structure that combines a decision tree model with a Markov model to cover long-term survival 13. Simulated patient cohorts entered the model at age 60.9 years, the mean age of the HORIZONS-AMI population, and were followed from primary hospitalisation to death.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor in the treatment of acute ST-segment elevation myocardial infarction

Schwenkglenks

Toward

Plent

et al. 2012

Heart

Self Cite

View full text Add to dashboard Cite

OBJECTIVE: To assess the cost-effectiveness of bivalirudin versus heparin and glycoprotein IIb/IIIa inhibitor (H-GPI) in patients undergoing primary percutaneous coronary intervention (PPCI) for acute ST-segment elevation myocardial infarction (STEMI), from a UK health service perspective. DESIGN: Cost-utility analysis with life-long time horizon. MAIN OUTCOME MEASURES: Costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness. METHODS: Event risks and medical resource use data derived from the HORIZONS-AMI trial were entered into a decision analytic model. Clinical events until the end of year 1 (main model) or year 3 (alternative model) were modelled in detail. Adjustments were applied to approximate UK routine practice characteristics. Life expectancy of 1-year or 3-year survivors, health-state utilities, initial hospitalisation length of stay in the comparator strategy and unit costs were based on UK sources. Costs and effects were discounted at 3.5%. RESULTS: The main model predicted bivalirudin and H-GPI patients to survive 11.52 and 11.35 (undiscounted) years on average, respectively, and to accrue 6.26 and 6.17 QALYs. Patient lifetime costs were £267 lower in the bivalirudin strategy (£12 843 vs £13 110). Extensive sensitivity and scenario analyses confirmed these results to be robust. In probabilistic analysis, quality-adjusted survival was higher and costs were lower with bivalirudin in 95.0% of simulation runs. In 99.2%, cost-effectiveness was better than £20 000 per QALY gained. Results from the alternative model were fully consistent. CONCLUSION: The use of bivalirudin instead of H-GPI in STEMI patients undergoing PPCI is cost-effective, and offers a high probability of dominance. Background treatment with aspirin and clopidogrel is assumed. and unit costs were based on UK sources. Costs and effects were discounted at 3.5%. Results:The main model predicted bivalirudin and H-GPI patients to survive 11.52 and 11.35 (undiscounted) years on average, respectively, and to accrue 6.26 and 6.17 QALYs. Patient lifetime costs were £267 lower in the bivalirudin strategy (£12,843 versus £13,110). Extensive sensitivity and scenario analyses confirmed these results to be robust. In probabilistic analysis, quality-adjusted survival was higher and costs were lower with bivalirudin, in 95.0% of simulation runs. In 99.2%, cost-effectiveness was better than £20,000 per QALY gained.Results from the alternative model were fully consistent. Conclusion:The use of bivalirudin instead of H-GPI in STEMI patients undergoing PPCI is cost-effective, and offers a high probability of dominance. Background treatment with aspirin and clopidogrel is assumed.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor in the treatment of acute ST-segment elevation myocardial infarction

Schwenkglenks

Toward

Plent

et al. 2012

Heart

Self Cite

View full text Add to dashboard Cite

show abstract

“…A cost-effective model from the UK perspective, that used data inputs from the ACUITY trial, also found bivalirudin to be cost effective (though not cost saving) 10. However, until the present study10a no economic evaluation of bivalirudin in patients with STEMI undergoing primary PCI has appeared in the literature.…”

mentioning

confidence: 67%

“…In this edition of Heart , Schwenkglenks et al 10a present a model-based cost-effectiveness analysis from the UK perspective of bivalirudin versus UFH + GPI for patients with STEMI, who were undergoing primary PCI, based on results from HORIZONS-AMI. Using a similar model structure as previously used in their ACUITY-based study,10 the authors report lower lifetime costs and increased quality-adjusted life expectancy with bivalirudin, with 95% of simulations rendering bivalirudin a dominant strategy. Although the results of these studies are not surprising, they do fill an important gap in the economic literature relating to bivalirudin, and were also instrumental in the recent approval of bivalirudin issued by the National Institute for Health and Clinical Excellence (NICE),11 for patients with STEMI, who were undergoing primary PCI, against the alternative of UFH + GPI.…”

mentioning

confidence: 98%

Understanding the cost-effectiveness of bivalirudin

Amin

Magnuson

2012

Heart

View full text Add to dashboard Cite

Clinical Research of Treatment with Tirofiban for High-Risk Non-ST-Segment Elevation Acute Coronary Syndrome During Peri-Operative Intervention Operation Period

Liu

Hou

Ren

et al. 2014

Cell Biochem Biophys

View full text Add to dashboard Cite

The objectives of this study are to explore the clinical effects of treatment with tirofiban for high-risk non-ST-segment elevation acute coronary syndrome (NSTE ACS) during peri-operative intervention operation period and to improve the level of clinical treatment. Ninety cases of high-risk NSTE ACS patients were randomly selected from January 2011 to April 2013 as the research objects, which were divided into two groups: the control group and the observation group. The control group received conventional aspirin, clopidogrel anticoagulation, coronary angiography, and percutaneous coronary interventional (PCI) treatment, while the observation group took tirofiban treatment in addition to the treatment of control group. The differences in major adverse cardiovascular events, TIMI flow grading, and complications of the two groups were observed after treatment. There were significant differences (P < 0.05) in the distal vascular blockage of major adverse cardiovascular events, intra-operative no-reflow, reoccurrence of acute myocardial infarction and stenocardia, and post-PCI TIMI flow grades 2 and 3. But in terms of bleeding complications, and TIMI flow grades 0 and 1 before PCI and after PCI, there was no significant difference (P > 0.05). Application of tirofiban treatment for high-risk NSTE ACS during the peri-intervention period is safe and effective, which can improve TIMI flow, increase tissue perfusion, and reduce postoperative complications.

show abstract

Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor in the treatment of non–ST-segment elevation acute coronary syndromes

Abstract: Treating NSTE-ACS patients undergoing invasive management with bivalirudin is likely to represent a cost-effective option for the United Kingdom, when compared with the current practice of using heparin and a GPI.

Cited by 17 publications

References 25 publications

Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor in the treatment of acute ST-segment elevation myocardial infarction

Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor in the treatment of acute ST-segment elevation myocardial infarction

Understanding the cost-effectiveness of bivalirudin

Clinical Research of Treatment with Tirofiban for High-Risk Non-ST-Segment Elevation Acute Coronary Syndrome During Peri-Operative Intervention Operation Period

Contact Info

Product

Resources

About